Efficacy of three-dimensional models for medical education: A systematic scoping review of randomized clinical trials

To estimate the efficacy of three-dimensional (3D) models for medical education.

METHODS

A systematic scoping review was performed containing diverse databases such as SCOPUS, PubMed/MEDLINE, SCIELO, and LILACS. MeSH terms and keywords were stipulated to explore randomized clinical trials (RCTs) in all languages. Solely RCTs that accomplished the eligibility criteria were admitted.

RESULTS

Fifteen RCTs including 1659 medical students were chosen. Five RCTs studied heart models, 3 RCTs explored facial, spinal and bone fractures and the rest of the trials investigated eye, arterial, pelvic, hepatic, chest, skull, and cleft lip and palate models. Regarding the efficacy of 3D models, in terms of learning skills and knowledge gained by medical students, most RCTs reported higher scores. Considering the test-taking times, the results were variable. Two RCTs showed less time for the 3D group, another RCT indicated variable results in the response times of the test depending on the anatomical zone evaluated, while another described that the students in the 3D group were slightly quicker to answer all questions when compared with the traditional group, but without statistical significance. The other 11 experiments did not present results about test-taking times. Most students in all RCTs indicated satisfaction, enjoyment, and interest in utilizing the 3D systems, and recognized that their abilities were enhanced.

CONCLUSIONS

Higher efficacy in terms of learning skills and knowledge gained was observed when the 3D systems were used by medical students. Undergraduates also expressed great satisfaction with the use of these technologies. Regarding the test-taking times, the results favored the 3D group.

Relationship between Gram negative enteric rods, Aggregatibacter actinomycetemcomitans, and clinical parameters in periodontal disease

BACKGROUND

The association between Gram negative enteric rods and Aggregatibacter actinomycetemcomitans in periodontal diseases has received little attention in the literature. The objective of this study was to explore the relationship between these organisms and clinical parameters of periodontal disease.

MATERIALS AND METHODS

Clinical parameters and occurrence of Gram-negative enteric rods and A. actinomycetemcomitans were examined in 76 patients with chronic periodontitis. Chi-square and Mann-Whitney tests were used to determine differences in clinical variables versus the presence or absence of both microorganisms. Correlation among both organisms and clinical data were determined using Spearman rank correlation coefficient.

RESULTS

Gram-negative enteric rods and A. actinomycetemcomitans were detected in 20 (26.3%) and 18 (23.7%) individuals, respectively. A total of 14 (18.4%) patients harbored both microorganisms studied. There were significantly positive correlations between enteric rods and presence of A. actinomycetemcomitans (r=0.652, P<0.0001). Both microorganisms were significant and positively correlated with probing depth (PD), clinical attachment level, and bleeding on probing (P<0.0001). The mean PD (mm) of the sampled sites was significantly deeper in patients with presence of A. actinomycetemcomitans and Gram-negative enteric rods.

CONCLUSION

The results of the present study suggest a strong positive correlation between Gram-negative enteric rods and A. actinomycetemcomitans in the population studied. This finding must be taken into account when considering the best therapeutic approach, including the utilization of antimicrobials. The adverse clinical outcomes observed in presence of these microorganisms could have implications in the pathogenesis of periodontal disease and a possible impact on outcomes after treatment.

Potential Clinical Application of Organs-on-a-Chip in Periodontal Diseases: A Systematic Review of In Vitro Studies

The periodontium is a unique organ from the standpoint of building an organ-on-a-chip (OoC) since it is a system that is continually threatened by microorganisms, their noxious compounds, and antigenic components. At the same time, periodontal health depends on a balanced connection between the host and the bacteria in the oral cavity, which is a complex micro-ecological environment. The objective of this systematic review of in vitro studies is to revise the potential clinical application of OoC in periodontal diseases. PRISMA was used to guide this analysis. The review framework made use of several databases, including SCOPUS, PubMed/MEDLINE, SCIELO, and LILACS as well as the gray literature. This systematic review comprised seven studies. The clinical efficacy of OoC in periodontal diseases was observed in models of the gingival crevice for the research of periodontitis, periodontal medication analysis, the interaction of multiple microbial species, pH measurements in in situ-grown biofilm, testing antimicrobial reagents, evaluation of mucosal interactions with microorganisms, and a device for quantitative exploration of microorganisms. OoC has the potential to advance our understanding of periodontal diseases by providing a more accurate representation of the oral microenvironment and enabling the development of new treatments.

Applications of Lab on a Chip in Antimicrobial Susceptibility of Staphylococcus aureus: A Systematic Review

Background and Objectives: Staphylococcus aureus is a prevalent bacterium capable of inducing various infections, including skin and soft tissue infections, bloodstream infections, pneumonia, and surgical site infections. The emergence of antimicrobial resistance in S. aureus, particularly methicillin-resistant S. aureus, has raised substantial concerns within global healthcare settings. Prior to antibiotic prescription, the ideal approach is antimicrobial susceptibility testing (AST); however, this is frequently perceived as excessively complex and time-intensive. Lab-on-a-chip (LOC) technology holds promise in addressing these challenges and advancing fundamental microbiological research while also aiding in the development of therapeutic strategies. This systematic review aims to evaluate the potential utility of LOC for AST of S. aureus. Materials and Methods: This study adhered to the PRISMA guidelines. Various databases, including SCOPUS, PubMed/MEDLINE, SCIELO, and LILACS, in addition to gray literature sources, were employed in the review process. Results: Sixteen studies were included in this systematic review. All these studies detailed the effectiveness, rapidity, and predictability of LOC systems for assessing S. aureus susceptibility to various antibiotics. When comparing the LOC approach to traditional manual methods, it was evident that LOC requires a minimal quantity of reagents. Furthermore, most studies reported that the entire LOC procedure took 10 min to 7 h, with results being equally accurate as those obtained through traditional AST protocols. Conclusions: The potential application of LOC for AST of S. aureus is emphasized by its ability to provide rapid access to minimum inhibitory concentration data, which can substantially aid in selecting the most suitable antibiotics and dosages for treating challenging infections caused by this microorganism. Moreover, the rapid AST facilitated by LOC holds promise for enhancing the appropriateness and efficacy of therapy in clinical settings.

A Systematic Review of In Vitro Studies Using Microchip Platforms for Identifying Periodontopathogens from the Red Complex

Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola, collectively recognized as periodontopathogens within the red complex, have been extensively studied in clinical samples collected from individuals with periodontitis. A lab-on-a-chip (LOC) is a miniature mechanism that integrates various laboratory operations onto a single microchip or a small-scale platform. This systematic review evaluates the application of LOC technology in identifying microorganisms from the red complex. This study adhered to PRISMA recommendations, and the review process encompassed several databases. In the electronic search, a total of 58 reports were found, and ultimately, 10 studies were considered relevant for inclusion. All these studies described effective, rapid, and reliable LOC systems for detecting and amplifying P. gingivalis, T. forsythia, and T. denticola. Compared to traditional methods, the LOC approach demonstrated minimal reagent requirements. Additionally, the results indicated that the amplification process took approximately 2 to 8 min, while detection could be completed in as little as 2 min and 40 s, resulting in a total experimental duration of around 11 min. Integrating miniaturization, speed, accuracy, and automation within microchip platforms makes them promising tools for detecting and amplifying microorganisms associated with the red complex in periodontal diseases.

The Potential Clinical Applications of a Microfluidic Lab-on-a-Chip for the Identification and Antibiotic Susceptibility Testing of Enterococcus faecalis-Associated Endodontic Infections: A Systematic Review

This systematic review evaluated the potential clinical use of microfluidic lab-on-a-chip (LOC) technology in the identification and antibiotic susceptibility testing of E. faecalis in endodontic infections. The search methodology employed in this review adhered to the PRISMA guidelines. Multiple scientific databases, including PubMed/MEDLINE, SCOPUS, and SCIELO, were utilized, along with exploration of grey literature sources. Up to September 2023, these resources were searched using specific keywords and MeSH terms. An initial comprehensive search yielded 202 articles. Ultimately, this systematic review incorporated 12 studies. Out of these, seven aimed to identify E. faecalis, while the remaining five evaluated its susceptibility to different antibiotics. All studies observed that the newly developed microfluidic chip significantly reduces detection time compared to traditional methods. This enhanced speed is accompanied by a high degree of accuracy, efficiency, and sensitivity. Most research findings indicated that the entire process took anywhere from less than an hour to five hours. It is important to note that this approach bypasses the need for minimum inhibitory concentration measurements, as it does not rely on traditional methodologies. Microfluidic devices enable the rapid identification and accurate antimicrobial susceptibility testing of E. faecalis, which are crucial for timely diagnosis and treatment in endodontic infections.

Antibiotic Resistance in Patients with Peri-Implantitis: A Systematic Scoping Review

The implementation of adjunctive antibiotics has been recommended for the therapy of peri-implantitis (PI). In this review, antibiotic resistance patterns in PI patients were assessed. A systematic scoping review of observational studies and trials was established in conjunction with the PRISMA extension for scoping reviews. The SCOPUS, PubMed/MEDLINE, EMBASE, SCIELO, Web of Science, and LILACS databases were reviewed along with the gray literature. The primary electronic examination produced 139 investigations. Finally, four observational studies met the selection criteria. These studies evaluated 214 implants in 168 patients. Porphyromonas gingivalis and Fusobacterium nucleatum mainly presented high resistance to tetracycline, metronidazole, and erythromycin in PI patients. Similarly, Aggregatibacter actinomycetemcomitans was also highly resistant to clindamycin and doxycycline. Other microorganisms such as Tannerella forsythia, Parvimonas micra, and Prevotella intermedia/nigrescens also presented significant levels of resistance to other antibiotics including amoxicillin, azithromycin, and moxifloxacin. However, most microorganisms did not show resistance to the combination amoxicillin metronidazole. Although the management of adjunctive antimicrobials in the therapy of PI is controversial, in this review, the resistance of relevant microorganisms to antibiotics used to treat PI, and usually prescribed in dentistry, was observed. Clinicians should consider the antibiotic resistance demonstrated in the treatment of PI patients and its public health consequences.

Kounis Syndrome Secondary to Laxative Administration

Kounis syndrome (KS) is defined as an acute coronary syndrome triggered by the release of inflammatory mediators after an allergic attack. It usually occurs secondary to allergic injuries from foods, medications, and insect bites. However, there are no known reports of KS secondary to the intake of laxatives. This article reports the case of a 43-year-old woman who, after ingesting a dose of sodium phosphate monobasic/sodium phosphate dibasic, presented a maculopapular rash on the trunk and extremities. The electrocardiogram showed ST depression in V4-V5-V6 and signs of prolonged QTc; troponin I uptake was positive. Due to presumed myocardial injury and high suspicion of coronary disease, coronary angiography was requested, which showed epicardial coronary arteries, without angiographically significant stenosis, thus confirming the presence of KS secondary to the ingestion of a laxative.

Clinical Efficacy of Treatment of Endodontic-Periodontal Lesions: A Systematic Scoping Review of Experimental Studies

BACKGROUND

In this review, we evaluated the clinical efficacy of interventions used for the treatment of endo-perio lesions (EPL).

METHODS

A systematic scoping review of clinical trials was developed.

RESULTS

Seven clinical trials were studied. In at least one study group of six of the seven evaluated trials, endodontic and periodontal treatments were performed simultaneously. All trials showed improvement in probing depth in the studied groups; nevertheless, the experimental groups of five studies demonstrated a statistically significant reduction in this parameter. An increase in clinical attachment level was also reported (p < 0.05). Most trials reported an increase in the filling of the bone defect following therapy (p < 0.05). Mechanical periodontal therapy implemented simultaneously with endodontic therapy demonstrated efficacy in the treatment of concurrent EPL without communication. Endodontic treatment and immediate periodontal surgery did not affect the result of the management of combined EPL with apical communication. The use of diode laser, the management of platelet-rich fibrin (PRF) and titanium-prepared PRF, and the implementation of bone grafts plus endodontic treatment with mineral-trioxide or gutta-percha seems to be an adequate strategy in patients with EPL.

CONCLUSIONS

The treatment of EPL using simultaneous endodontic and periodontal therapies seems to be an acceptable treatment alternative.

Portal Vein Thrombosis in Liver Transplantation: A Retrospective Cohort Study

Portal vein thrombosis was considered a contraindication for liver transplantation. This study analyzes the perioperative complications and survival of liver transplant patients with portal vein thrombosis (PVT). A retrospective observational cohort study of liver transplant patients was conducted. The outcomes were early mortality (30 days) and patient survival. A total of 201 liver transplant patients were identified and 34 (17%) patients with PVT were found. The most frequent extension of thrombosis was Yerdel 1 (58.8%), and a portosystemic shunt was identified in 23 (68%) patients. Eleven patients (33%) presented any early vascular complication, PVT being the most frequent (12%). The multivariate regression analysis showed a statistically significant association between PVT and early complications (OR = 3.3, 95% confidence interval 1.4-7.7; p = 0.006). Moreover, early mortality was observed in eight patients (24%), of which two (5.9%) presented Yerdel 2. For Yerdel 1, patient survival according to the extent of thrombosis was 75% at 1 year and 3 years, while for Yerdel 2, it was 65% at 1 year, and 50% at 3 years (p = 0.04). Portal vein thrombosis significantly influenced early vascular complications. Furthermore, portal vein thrombosis Yerdel 2 or higher impacts the survival of liver grafts in the short and long term.

Ischemic Stroke Secondary to a Stab Wound to the Neck in a Young Adult

Vertebral artery dissection is a common cause of stroke in young adults without predisposing risk factors for cerebrovascular disease. We describe the case of a 28-year-old patient who presented with an ischemic stroke secondary to a stab wound to the neck that affected the vertebral artery. A physical examination revealed neurological deterioration (Glasgow 8/15), a sutured neck wound, no palpable hematoma, no thrills, and no active bleeding. A computed tomography angiography revealed a left vertebral artery arteriovenous fistula with a component of a pseudoaneurysm, for which a neurointerventional consultation was carried out. Due to neurological compromise, the airway was secured, and because the case involved a posterior fossa infarction with compression of the fourth ventricle and obstructive secondary hydrocephalus, an external ventricular shunt was inserted by neurosurgery. A fistula occlusion was performed with five Axium coils and a vial of Squid 12; the vertebral artery was catheterized, and a craniotomy was performed to manage hydrocephalus with a 12-mm H2O collecting system. The patient was discharged on the tenth day after admission with sequelae of left hemiparesis (predominantly brachial) and no other deficits. There was no hemorrhagic transformation on the control computed tomography scans and no further complications.

Efficacy of antimicrobials in preventing resistance in solid organ transplant recipients: A systematic review of clinical trials

BACKGROUND

In the absence of effective antimicrobials, transplant surgery is not viable, and antirejection immunosuppressants cannot be administered, as resistant infections compromise the life-saving goal of organ transplantation.

AIM

To evaluate the efficacy of antimicrobials in preventing resistance in solid organ transplant recipients.

METHODS

A systematic review was conducted using a search methodology consistent with the preferred reporting items for systematic reviews and meta-analyses. This review included randomized clinical trials that evaluated the efficacy of antimicrobial agents (prophylactic or therapeutic) aimed at preventing antimicrobial resistance. The search strategy involved analyzing multiple databases, including PubMed/MEDLINE, Web of Science, Embase, Scopus, and SciELO, as well as examining gray literature sources on Google Scholar. A comprehensive electronic database search was conducted from the databases' inception until May 2024, with no language restrictions.

RESULTS

After the final phase of the eligibility assessment, this systematic review ultimately included 7 articles. A total of 2318 patients were studied. The most studied microorganisms were cytomegalovirus, although vancomycin-resistant enterococci, Clostridioides difficile, and multidrug-resistant Enterobacterales were also analyzed. The antimicrobials used in the interventions were mainly maribavir, valganciclovir, ganciclovir, and colistin-neomycin. Of concern, all clinical trials showed significant proportions of resistant microorganisms after the interventions, with no statistically significant differences between the groups (mean resistance 13.47% vs 14.39%), except for two studies that demonstrated greater efficacy of maribavir and valganciclovir (mean resistance 22.2% vs 41.1% in the control group; P < 0.05). The total reported deaths in three clinical trials were 75, and there were 24 graft rejections in two studies.

CONCLUSION

All clinical trials reported significant proportions of antimicrobial-resistant microorganisms following interventions. More high-quality randomized clinical trials are needed to corroborate these results.

Efficacy of the finite element analysis in assessing the effects of light curing on the mechanical properties of direct restorative composites: A systematic review

BACKGROUND

Previous studies have identified the effects of light curing techniques on both shrinkage strain and contraction stress buildup in composite restorations. Finite Element Analysis (FEA) has several advantages over other experimental methods for evaluating the mechanical properties of direct dental resins. The objective of this systematic review is to assess the impact of light curing protocols on the shrinkage behaviors and other mechanical properties of direct restorative composites utilizing FEA.

MATERIAL AND METHODS

The search methodology adhered to the PRISMA guidelines and utilized prominent scientific databases. This systematic review was structured around a question formulated PICO framework. To estimate the methodological rigor of the included studies, a quality assessment tool was utilized.

RESULTS

After the final phase of eligibility evaluation, the systematic review incorporated nine studies. Studies employing FEA primarily aimed to investigate the effects of various light curing protocols on shrinkage behaviors, contraction stress, and microleakage in composite restorations. Most FEA models in these studies incorporated key time-dependent parameters related to composite polymerization, such as shrinkage, Young's modulus, Poisson ratio, and resulting creep. FEA can provide valuable insights into the effects of light curing on the mechanical properties of direct restorative composites, its accuracy, and reliability depend on various factors, including the accuracy of input parameters, modeling assumptions, and validation against experimental data.

CONCLUSIONS

The findings underscore the importance of considering various factors such as curing protocol, testing method, composite characteristics, and environmental conditions in understanding, and mitigating the adverse effects of polymerization shrinkage in composite restorations. Key words:Finite Element Analyses, Composite Resins, Light Curing of Dental Resins, Polymerization, Materials Testing, Mechanical Tests.

ST‑segment elevation associated with intraparenchymal hemorrhage: A case report

The electrocardiogram (ECG) changes in patients with intraparenchymal hemorrhage (IPH) have remained largely elusive and no case reports are currently available in the scientific literature. The medical management of a patient with ST-segment elevation associated with IPH was described in the present study. The case report describes a 78-year-old male patient who presented with ST-segment elevation in V1, V2, V3 and V4 on ECG. Initially, the case was managed therapeutically as an acute myocardial infarction. Later, the patient was transferred to a higher-level hospital, where a new ECG confirmed ST-segment elevation. Simple skull tomography was also performed, which revealed a spontaneous right basal ganglion in the context of an acute cerebrovascular accident of hypertensive origin. A transthoracic ECG was ordered, which revealed an ejection fraction of 65% with type I diastolic dysfunction due to relaxation disorders and without any signs of ischemia, intracavitary masses or thrombi. In addition to the presence of nonspecific ECG findings, clinicians should consider immediate brain computed tomography to confirm intracranial hemorrhage.

Advancing healthcare through laboratory on a chip technology: Transforming microorganism identification and diagnostics

In a recent case report in the World Journal of Clinical Cases, emphasized the crucial role of rapidly and accurately identifying pathogens to optimize patient treatment outcomes. Laboratory-on-a-chip (LOC) technology has emerged as a transformative tool in health care, offering rapid, sensitive, and specific identification of microorganisms. This editorial provides a comprehensive overview of LOC technology, highlighting its principles, advantages, applications, challenges, and future directions. Success studies from the field have demonstrated the practical benefits of LOC devices in clinical diagnostics, epidemiology, and food safety. Comparative studies have underscored the superiority of LOC technology over traditional methods, showcasing improvements in speed, accuracy, and portability. The future integration of LOC with biosensors, artificial intelligence, and data analytics promises further innovation and expansion. This call to action emphasizes the importance of continued research, investment, and adoption to realize the full potential of LOC technology in improving healthcare outcomes worldwide.

Graph Neural Networks-Based Prediction of Drug Gene Interactions of RTK-VEGF4 Receptor Family in Periodontal Regeneration

BACKGROUND

The RTK-VEGF4 receptor family, which includes VEGFR-1, VEGFR-2, and VEGFR-3, plays a crucial role in tissue regeneration by promoting angiogenesis, the formation of new blood vessels, and recruiting stem cells and immune cells. Machine learning, particularly graph neural networks (GNNs), has shown high accuracy in predicting these interactions. This study aims to predict drug-gene interactions of the RTK-VEGF4 receptor family in periodontal regeneration using graph neural networks.

MATERIAL AND METHODS

The study utilized a dataset comprising 19,154 drug-gene interactions to analyze the relationships between drugs and protein-coding genes. The dataset was split into training and testing sets, with 80% of the data used for training and 20% for testing. Cytoscape, an open-source software platform, was employed to visualize and analyze the drug-gene interaction network, and CytoHubba, a plugin, was used to identify highly connected nodes. Topological measures were applied to determine the influence and importance of each node. GNNs were used to manage the complex relationships and dependencies within the graphs.

RESULTS

The drug-gene interaction network, comprising 815 nodes and 13,436 edges, was found to be complex and highly interconnected. It was divided into 11 components, displaying low density and heterogeneity, indicative of a sparse structure. The GNN model achieved 97% accuracy in predicting interaction types, including single protein interactions and protein complex groups.

CONCLUSIONS

The study demonstrates that graph neural networks outperform traditional machine learning methods in predicting drug-gene interactions within the RTK-VEGF protein family in periodontal regeneration, highlighting their potential in advancing therapeutic strategies and drug discovery. Key words:Graph neural networks; drug-gene interactions; RTK-VEGF4 protein family: periodontal regeneration.

Histological Evaluation of Internal Dental Resorption: An Analysis of a Cohort of 50 Cases

OBJECTIVE

This study aimed to perform a histological evaluation of teeth diagnosed with internal root resorption.

MATERIALS AND METHODS

A descriptive study involved the examination of 50 human teeth extracted due to an unfavorable prognosis for retention in the oral cavity. Teeth were preserved in 10% buffered formalin and subsequently subjected to the decalcification process. Masson-Goldner staining was applied for comprehensive histological assessment.

RESULTS

In all the 50 teeth examined, resorption gaps within the dentin tissue were identified, accompanied by the presence of reparative cells in the vicinity of these cavities. Marked structural loss and dentin fragmentation were evident, with regions exhibiting fissures and an absence of dentinal tubules.

CONCLUSIONS

The histological evaluation of 50 teeth diagnosed with internal dental resorption revealed significant structural alterations, including resorption lacunae, the presence of multinucleated osteoclast-like cells, and reparative connective tissue. These findings highlight the complex and multifaceted nature of internal dental resorption. These histological insights provide a deeper understanding of the pathological processes involved in internal dental resorption and underscore the necessity for early detection and intervention to mitigate tooth loss and preserve dental health.

Artificial intelligence as a predictive tool for gastric cancer: Bridging innovation, clinical translation, and ethical considerations

With gastric cancer ranking among the most prevalent and deadly malignancies worldwide, early detection and individualized prognosis remain essential for improving patient outcomes. This letter discusses recent advancements in artificial intelligence (AI)-driven predictive tools for gastric cancer, emphasizing a computed tomography-based radiomic model that achieved a predictive accuracy of area under the curve of 0.893 for treatment response in advanced cases undergoing neoadjuvant immunochemotherapy. AI offers promising avenues for predictive accuracy and personalized treatment planning in gastric oncology. Additionally, this letter highlights the comparison of these AI tools with traditional methodologies, demonstrating their potential to streamline clinical workflows and address existing gaps in risk stratification and early detection. Furthermore, this letter addresses the ethical considerations and the need for robust clinical-AI collaboration to achieve reliable, transparent, and unbiased outcomes. Strengthening cross-disciplinary efforts will be vital for the responsible and effective deployment of AI in this critical area of oncology.

Gradient boosting-based classification of interactome hub genes in periimplantitis with periodontitis - an integrated bioinformatic approach

INTRODUCTION

Peri-implantitis, a destructive inflammatory condition affecting the tissues surrounding dental implants, shares pathological similarities with periodontitis, a chronic inflammatory disease that impacts the supporting structures of natural teeth. This study utilizes a network-based approach to classify interactome hub genes associated with peri-implantitis and periodontitis, aiming to improve understanding of disease mechanisms and identify potential therapeutic targets.

METHODS

We employed gradient boosting and Weighted Gene Co-expression Network Analysis (WGCNA) to predict and classify these interactome hub genes. Gene expression data related to these diseases were sourced from the NCBI GEO dataset GSE223924, and differential gene expression analysis was conducted using the NCBI GEO R tool. Through WGCNA, we constructed a co-expression network to identify key hub genes, while gradient boosting was used to predict these hub genes.

RESULTS

Our analysis revealed a co-expression network comprising 216 genes, including prominent hub genes such as IL17RC, CCN2, BMP7, TPM1, and TIMP1, which are implicated in periodontal disease. The gradient boosting model achieved an 88.2% accuracy in classifying interactome hub genes in samples related to peri-implantitis and periodontitis.

DISCUSSION

These identified genes play roles in inflammation, osteoclast genesis, angiogenesis, and immune response regulation. This study highlights essential hub genes and molecular pathways associated with peri-implantitis and periodontitis, suggesting potential therapeutic targets for developing innovative treatment strategies.

A Systematic Review of Randomized Clinical Trials Evaluating the Efficacy of Minimally Invasive Surgery for Soft Tissue Management: Aesthetics, Postoperative Morbidity, and Clinical Results

Background and Objectives: The necessity for less invasive and patient-friendly surgical therapies guided the development of the "minimally invasive surgical technique" (MIST). The aim of this systematic review was to evaluate the efficacy of MIST for soft tissue management considering aesthetic results, postoperative morbidity, and clinical outcomes. Materials and Methods: Several databases were used to conduct a thorough analysis of the scientific evidence. To investigate randomized clinical trials (RCTs), MeSH terms and keywords were provided. Results: Eleven RCTs were chosen. These experiments included 273 patients. The trials that explored MIST for papilla preservation presented greater efficacy in increasing papillary height (p < 0.05). MIST showed stable clinical outcomes for the management of excessive gingival display and with a flapless technique for single implant placement. Considering the treatment of gingival recessions, some RCTs presented greater root coverage with MIST (p < 0.05), while other trials did not show differences between groups. Regarding aesthetic perception, five RCTs indicated high patient satisfaction with MIST (p < 0.05). Similarly, six RCTs reported that patients in the MIST group presented significantly less post-surgical pain and lower wound healing scores (p < 0.01). Conclusions: It was concluded that using MIST resulted in more clinical studies reporting better clinical outcomes. Considering aesthetic appearance, slightly more than half of the clinical trials also showed improved results with MIST. Likewise, regarding postoperative morbidity, 60% of the clinical trials also described better scores with MIST. All of this indicates that MIST is a good alternative for the management of soft tissues.

Machine learning for predicting antimicrobial resistance in critical and high-priority pathogens: A systematic review considering antimicrobial susceptibility tests in real-world healthcare settings

BACKGROUND

Antimicrobial resistance (AMR) poses a worldwide health threat; quick and accurate identification of AMR enhances patient outcomes and reduces inappropriate antibiotic usage. The objective of this systematic review is to evaluate the efficacy of machine learning (ML) approaches in predicting AMR in critical and high-priority pathogens (CHPP), considering antimicrobial susceptibility tests in real-world healthcare settings.

METHODS

The search methodology encompassed the examination of several databases, such as PubMed/MEDLINE, EMBASE, Web of Science, SCOPUS, and SCIELO. An extensive electronic database search was conducted from the inception of these databases until November 2024.

RESULTS

After completing the final step of the eligibility assessment, the systematic review ultimately included 21 papers. All included studies were cohort observational studies assessing 688,107 patients and 1,710,867 antimicrobial susceptibility tests. GBDT, Random Forest, and XGBoost were the top-performing ML models for predicting antibiotic resistance in CHPP infections. GBDT exhibited the highest AuROC values compared to Logistic Regression (LR), with a mean value of 0.80 (range 0.77-0.90) and 0.68 (range 0.50-0.83), respectively. Similarly, Random Forest generally showed better AuROC values compared to LR (mean value 0.75, range 0.58-0.98 versus mean value 0.71, range 0.61-0.83). However, some predictors selected by these algorithms align with those suggested by LR.

CONCLUSIONS

ML displays potential as a technology for predicting AMR, incorporating antimicrobial susceptibility tests in CHPP in real-world healthcare settings. However, limitations such as retrospective methodology for model development, nonstandard data processing, and lack of validation in randomized controlled trials must be considered before applying these models in clinical practice.

Efficacy of CAD/CAM technology in dental procedures performed by students: A systematic scoping review of randomized clinical trials

To assess the efficacy of computer-aided design/computer-aided manufacturing (CAD/CAM) in dental procedures performed by dental students.

METHODS

A systematic scoping review was performed. MeSH terms and keywords were specified to assess randomized clinical trials (RCTs) in all idioms.

RESULTS

Nine RCTs that include 520 students were selected. Two RCTs studied implant placement, and the rest of the trials explored implant impressions, intraoral scans, canal obturation, head positioning errors in panoramic images, deep caries and pulp exposure, diagnosis of temporomandibular disorders, and a tooth for restorations. Considering efficacy, variable results were found. The RCTs that explored implant impressions, deep caries and pulp exposure, and diagnosis of temporomandibular disorders showed better results when CAD/CAM technology was performed by students. Two RCTs that investigated implant placement presented contradictory outcomes; one showed better results when CAD/CAM systems were used while the other described similar results to conventional methods. The remaining RCTs did not find differences with conventional procedures. Considering the time spent during the procedures, two studies showed no differences between groups, while another indicated that the time spent was less for digital impressions (p < 0.001). A continuous decrease in scanning time was also perceived for all groups as skills in intraoral scanning augmented (p = 0.0005). Students indicated an interest in utilizing the CAD/CAM systems and recognized that their abilities were enhanced.

CONCLUSIONS

Considering the limitations of this review and the limited number of RCTs evaluated, students recognized that their skills improved using CAD/CAM systems; however, only in some specific procedures greater efficacy and less time spent were observed when this technology was used. Dental students also showed great interest in using these techniques.

Enhanced hierarchical attention networks for predictive interactome analysis of LncRNA and CircRNA in oral herpes virus

BACKGROUND

Non-coding RNAs, including lncRNAs, circRNAs, and microRNAs, constitute 98 % of the human transcriptome and are vital regulators of gene expression, cellular processes, and host-pathogen interactions, particularly in viral infections. This study explores lncRNA-circRNA interactions and their biological significance in oral viral infections.

METHODS

ViRBase, a database with over 820,000 interactions involving 50,000 RNAs from 116 viruses and 36 host organisms, was used to analyze herpesvirus datasets. The study employed hierarchical attention and knowledge graph embeddings to represent nodes and edges in the knowledge graph. These served as input features for a hierarchical attention model trained over 100 epochs. Model performance was evaluated based on loss calculation, optimization, and attention weight stability.

RESULTS

The model achieved a final loss of 0.000180 at Epoch 100, with stable attention weights confirming reliability. Node embedding statistics showed a mean of 0.005110 and a standard deviation of 0.013370, while attention weights had a high mean of 0.997178, emphasizing model robustness.

CONCLUSION

This study provides insights into lncRNA-circRNA interactions in herpes viral infections, enhancing therapeutic development, disease progression monitoring, and understanding host-pathogen interactions, paving the way for targeted interventions and improved outcomes.

Endoscopic vacuum assisted closure therapy for esophagopericardial fistula in a 16-year-old male: A case report

BACKGROUND

Esophagopericardial fistula (EPF) is a rare, life-threatening condition with limited scientific literature and no established management guidelines. This case report highlights a successful multidisciplinary approach and the innovative use of endoscopic vacuum assisted closure (endoVAC) therapy in treating this complex condition.

CASE SUMMARY

A 16-year-old male with a history of esophageal atresia and colon interposition presented with progressive chest pain, fever, and dyspnea. Imaging revealed an EPF with associated pleural and pericardial effusions. Initial management with an esophageal stent failed, prompting the use of an endoVAC system. The patient underwent multiple endoVAC device changes and received broad-spectrum antibiotics and nutritional support. The fistula successfully closed, and the patient recovered, demonstrating no new symptoms at a 6-month follow-up.

CONCLUSION

EndoVAC therapy can effectively manage EPF, providing a minimally invasive treatment option.

Conservative Medical Management of a Tracheal Perforation after Blunt Trauma in a Patient with SARS-CoV-2

This article reports the case of a woman with tracheal perforation due to closed neck trauma and the presence of SARS-CoV-2. The physical examination revealed subcutaneous emphysema in zone II of the neck. The tomography revealed an anterior and proximal tracheal lesion, a 2-mm solution of continuity of the anterior infraglottic airway in the proximal third with subcutaneous emphysema and a decrease in the diameter of the airway at the level of the glottis. The PCR result for SARS-CoV-2 was positive. The medical procedure consisted of orotracheal intubation to guarantee the safety of the airway, in addition to close surveillance in the intensive care unit and constant monitoring of vital signs. In tracheal perforation due to closed neck trauma, it is recommended to evaluate the clinical parameters periodically, including the stability of respiration and subcutaneous emphysema.